Balancing Thoughts and Feelings About Food: A Mental Health Professional’s Creative Idea Guide to Treating Adolescent Eating Disorders In Individual or Group Settings

By Therese Tuski Scarpace LMSW ACSW

Social workers and others conducting group and individual therapy and counseling with adolescents battling eating disorders will find a treasure trove of useful information in Balancing Thoughts and Feelings about Food. Therese Tuski Scarpace, a longtime social worker, draws on her years of experience to share methods and techniques to engage adolescents, keep their interest, and help them overcome obstacles. The strategies she shares are based on cognitive behavioral therapy and dialectal behavioral therapy techniques—and they are expressed in creative formats. Scarpace begins by sharing foundation information, such as the research and assessment processes she relies on for best practices, and follows that up with practical ideas for preparing spaces for individual or group therapy sessions. She explains how to create a supportive team to help adolescents, ways to improve self-image, and how to implement various strategies to help young people succeed.

• Language: English
• Publisher: Lulu Publishing Services
• Release date: Jan 10, 2018
• ISBN: 9781483478302

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ACSW

Copyright © 2018 Therese Tuski Scarpace, LMSW, ACSW.

All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means—whether auditory, graphic, mechanical, or electronic—without written permission of the author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.

This book is a work of non-fiction. Unless otherwise noted, the author and the publisher make no explicit guarantees as to the accuracy of the information contained in this book and in some cases, names of people and places have been altered to protect their privacy.

ISBN: 978-1-4834-7831-9 (sc)

ISBN: 978-1-4834-7830-2 (e)

Library of Congress Control Number: 2017919280

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

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Lulu Publishing Services rev. date: 12/18/2017

To all those striving for balance in all aspects of their lives

The balance of art (creativity) and science is essential for positive outcomes in therapy. I would not be able to practice without using creativity.

—Megan Branstetter, LMSW

FOREWORD

It is with great pleasure that I write these comments regarding Balancing Thoughts and Feeling about Food by Therese Scarpace.

I have worked in the field of eating disorders for more than thirty-five years as a clinician and researcher, and in the past five years, I have had the opportunity to work with and observe Therese treating eating disorder adolescents in individual, family, and group treatments. Through her work at a unique program called the Bridge, where eating disorder adolescents were treated in a day-hospital format at a local hospital in southeast Michigan, and in the past several years, I have had an even more direct opportunity to observe her work in a private practice clinical setting where her group room and private office are in the practice of Dennis & Moye & Associates.

At least thirty million people of all ages and genders suffer from eating disorders in the United States: Hudson, J. I., Hirpi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61(3), 348–358.

The National Institute of Mental Health reports that 2.7 percent of teens between thirteen and eighteen have some of eating disorder issue: Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Study—Adolescent Supplement (NCS-A). J Am Academy of Child and Adolescent Psychiatry, 49(10): 980–989. Treatment ideas for this population are an ongoing need.

I had long ago concluded that ultimately successful treatment of adolescents with eating disorders required a clinical setting where adolescents could define how and why the eating disorders had become maladaptive coping skills for the stressors of their lives. These most often very bright and talented young people rarely come to treatment willingly or open their hearts and minds easily. In this book, there are dozens of techniques to help clinicians give adolescents tools that allow them to do the emotional work that leads to recovery. The book is filled with dozens of techniques to give them voices to their feelings and skills to use their, as Therese would say, most important tool, their brain.

These techniques are based on a thorough integration of the knowledge of state-of-the-art research and evidence-based treatment, including an in-depth knowledge of adolescent psychology and an understanding of group processes and the unique fears and challenges families face in their attempts to help their children suffering from these life-threatening disorders.

Throughout the book, creative techniques with much evidence of clinical efficacy are developed based on CBT (cognitive behavioral therapy) and DBT (dialectal behavioral therapy) and expressed in creative formats. While general workbooks and clinician guides for DBT and CBT are most helpful, the adaptation of basic concepts into a teen-friendly format can be more appealing to this population. A multitude of tools and props are used to translate these ideas into formats that are effective and appealing to adolescents who by nature are often hard to engage clinically—perhaps none more so than the eating disorder adolescent.

CBT is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do. For more information, you can go to the National Association of Cognitive Behavioral Therapists website: www.nacbt.org. Dialectal behavioral therapy is based on a cognitive-behavioral treatment approach. The problem-solving focus and behavioral focus is blended with acceptance-based strategies and dialectal concepts. For more information, you can go to www.linehaninstitute.org.

In this quest, Therese has developed a language that the group learns to use that seems to be more appealing and less threatening to adolescents than academic terminology. For example, the people who can support them in their recovery are called their squads. The squads are actively drawn into the treatment with the use of notebooks to note questions to ask about the squad. For example, Why do you need your parents or guardians on your team? Responses like Even though I am stubborn, I know I cannot do this alone, based on CBT’s cognitive restructuring, are used throughout this approach.

—Ann Weeks Moye, PhD

ACKNOWLEDGMENTS

My parents, Duchesne and Ed Tuski, gave me my foundation.

My husband, Dennis, gives me the gift of balance.

My children—Megan, my son-in-law, John, my grandson, John Henry, Matthew, and daughter in-law, Michelle, and stepchildren, Jim and Lena—have made me a better person.

My colleagues along the way inspired, challenged, and supported me.

I have had the honor of working with hundreds of individuals to find balance in their lives.

I have shared so many of life’s adventures with my friends.

Jessie Miller’s support and professionalism helped me put my creativity into words.

INTRODUCTION

After more than thirty years of practicing the science and art of social work, I feel it is time to share my ideas, strategies, tools, and activities with other practitioners so they might adapt them to enhance their own practices. In my career, I focused on work with children and adolescents and their families—in both individual and group settings. I have worked with clients who were struggling with various issues, including anxiety/depression, sexual or physical abuse, type 1 diabetes, physical impairments, learning differences, and self-worth. This book specifically addresses adolescents (gender nonspecific) and eating disorders since this is my current area of work. The information and ideas I present in this book can also be adapted to other target populations.

I am proud to call myself a social worker. I believe in the social work discipline and curriculum as an effective way to empower those individuals who need (even though they might not quite know it at the start of their interventions) support, guidance, and knowledge to better their lives. I have been a social worker on the front line or in the trenches for most of my career where I have worked in a direct service role. Additionally, I have advocated for change in the larger systems in which my client population interacts. In an extension of my one-on-one work, I have always been active in community, state, and national causes that could have positive outcomes for families as a whole and perhaps even the individual families I work with.

As I prepare for